(1) Background: There is a need for studies on population-level health literacy (HL) to identify the current state of HL within and between countries. We report comparative findings from 10 European countries (Austria, Belgium (Fl), Czechia, England, Estonia, Finland, Germany, Macedonia, Poland, and Slovakia) on adolescents’ HL and its associations with gender, family affluence (FAS), and self-rated health (SRH). (2) Methods: Representative data (N = 14,590; age 15) were drawn from the HBSC (Health Behavior in School-Aged Children) study. The associations between HL, gender, FAS, and SRH were examined via path models. (3) Results: The countries exhibited differences in HL means and in the range of scores within countries. Positive associations were found between FAS and HL, and between HL and SRH in each country. Gender was associated with differences in HL in only three countries. HL acted as a mediator between gender and SRH in four countries, and between FAS and SRH in each country. (4) Conclusions: The findings confirm that there are differences in HL levels within and between European countries, and that HL does contribute to differences in SRH. HL should be taken into account when devising evidence-informed policies and interventions to promote the health of adolescents.

Background: Health literacy (HL) is an important determinant of health and health behaviours, and there is a need to monitor HL levels among all population groups. It is therefore essential to develop instruments to assess HL during childhood and adolescence. The aim of this study was to examine the cross-national measurement invariance of the instrument Health Literacy for School-aged Children (HLSAC) in four European countries. Methods: The data were collected via standardized selfadministered anonymous questionnaires within classrooms in Finland, Poland, Slovakia, and Belgium. There were in total 1468 respondents (aged 13, N=690; aged 15, N= 778). The HLSAC instrument was used to measure the subjective HL of adolescents in each country. A multigroup confirmatory factor analysis was applied to test measurement invariance. Results: Configural and metric invariance was established, but scalar invariance did not hold. However, the instrument exhibited high internal consistency (α=.85) and showed adequate fit with the data. Moreover, the partial invariance allowed comparison of mean values across the countries in question. There were significant mean value differences between countries and age-groups. Conclusion: HL mean values (as assessed via the HLSAC instrument) can be compared across countries. The instrument has utility for large-scale international HL studies on adolescents.

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Background: Regular physical activity and doing well in school are important for growing adolescents. In this study, the associations between physical activity and perceived school performance (PSP) are examined together. Methods: Young adolescents from 42 countries (n = 193,949) in Europe and Canada were examined for associations between self-reported moderate to vigorous physical activity (MVPA) and PSP. Multinominal analyses were conducted with 0 to 2 days of MVPA and below average PSP as reference categories. Adjusted odds ratios and 95% confidence intervals were reported for pooled data and individual countries after controlling for family affluence scale. Results: Girls had better PSP than boys, yet more boys participated in daily MVPA than girls. The associations between PSP and MVPA were inverted U shaped. The strongest association for very good PSP was among young adolescents who reported 5 to 6 days MVPA (odds ratios = 2.3; 95% confidence interval, 2.1–2.4) after controlling for family affluence scale. Conclusions: Young adolescents with average or better PSP took part in at least 3 days of MVPA in a week, suggesting that participating in some MVPA was positively associated with PSP. More days of MVPA in a week, especially for young adolescents with below average PSP, would be beneficial for health and school performance.

(1) Background: The aim of this study was to explore the associations between health literacy and symptoms for eating disorders among adolescents, taking into consideration age and gender and whether this association is mediated by body image. (2) Methods: We used data on 5054 adolescents (mean age = 13.9, 51.7% boys) from the Health Behaviour in School-Aged Children study conducted in 2018 in Slovakia. We used logistic regression models to examine associations between level of health literacy and symptoms for eating disorders mediated by body image. (3) Results: Adolescents with low and medium levels of health literacy had a higher occurrence of reporting two or more symptoms of eating disorders (odds ratio (OR)/95% CI: 2.25/1.78–2.84 and 1.37/1.15–1.65). Adjustment for body image reduced the significance of association between low level of health literacy and symptoms for eating disorders by 26.4%, and association between medium level of health literacy and symptoms for eating disorders by 29.7%. (4) Conclusions: Adolescents who have a low health literacy level were found to have a higher probability of having symptoms for eating disorders, especially when they perceive themselves as fat. The study refers to potential theoretical frameworks for health literacy intervention that may provide guidelines for the intervention design and materials.